Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #2790
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
1303 NW LOVEJOY ST, PORTLAND, OR 97209-2785
(503) 205-6751
(503) 205-6750
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RP0002506
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2117426
PK
—
05
—
269307
—
OR
05
—
500603115
—
OR
Enumeration date
09/24/2008
Last updated
04/16/2020
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